Struggling with COVID-19—A Framework for Assessing Health System Performance
Round 1
Reviewer 1 Report
The subject of this study is timely and interesting. However, the research design, questions, hypotheses and methods should be presented more clearly and the contents should be supplemented. In addition, arguments and discussion of findings should be logically described to help academia. If the authors revise this paper, it will be able to provide enough theoretical and practical implications. Good luck!
Author Response
We would like to express our greatest appreciation for the helpful comments of the Reviewer that helped us to improve the paper. We could address each issue raised and are sure that the paper is now much clearer. Thank you very much for your thorough analysis of our paper!
Comment 1: “The subject of this study is timely and interesting. However, the research design, questions, hypotheses and methods should be presented more clearly and the contents should be supplemented.”
We made our best to present the research design more clearly. We added some paragraphs to section 3 Materials and Methods:
The paper aims to (1) develop a conceptual framework that would be helpful to evaluate the performance of health systems struggling with the SARS-CoV-2 pandemic and (2) test the feasibility of the proposed approach.
We posed a research question: does a higher assessment of a country health and health system capacity profile give better results in combating the health crisis in that country?
and:
The idea behind the proposed framework is quite simple. We assume that there are several elements (variables) that determine the country health and health system capacity profile. Health variables pose a certain burden to the functioning of health systems, consequently affecting the size and structure of the demand for healthcare services. On the other hand, a health system has a certain capacity profile, that probably affects on the way the pandemic is being managed. Finally, both sub-profiles pose a challenge to a health system, resulting in the outcomes. These outcomes can be interpreted both from the epidemiological as well as from the technical point of view.
Comment 2: “In addition, arguments and discussion of findings should be logically described to help academia. If the authors revise this paper, it will be able to provide enough theoretical and practical implications.”
We added some paragraphs to section “Discussion” :
The literature highlights also the problem of patient cost burden and their willingness to pay for health services. This issue might be of great importance while discussing health care coverage and delivery during the global health crisis (pandemic). Vuong Q.H. et al. evaluate the sensitivity of Vietnamese healthcare consumers against two groups of factors (demographic and socioeconomic-cognitive) regarding payment for periodic GHE (general health examinations), which are not covered by insurance [53]. Paper by Vuong Q.H. [54] represents the first research attempt to estimate the probabilities of Vietnamese patients falling into destitution due to financial burdens occurring during a curative hospital stay. Such studies tend to focus on Asia and developing countries. We did not address this issue in our research, which can be seen as the study limitation. The working and unemployed are insured in Poland within the system of universal social insurance (employed), and to some extend within state / regional budget (unemployed).. They receive health benefits in life-threatening situations as well as primary health care services.
and:
The results obtained in our study could not be directly compared to the findings of other authors. The reason is that there is a lack of up-to-date studies that would cover exactly the same issue i.e. health system performance under COVID-19 pandemic. Anyway, existing frameworks, proposed by WHO and GHSA seem to be insufficient and incomplete in terms of the wide range of problems generated by pandemic (such as setting priorities in accessing and using care, mapping out the role of primary care physicians, cost burden reduction etc.). Our proposal is also not universal, but can be perceived as a first attempt to fit the model framework to the contextual conditions of care in a pandemic.
Reviewer 2 Report
Dear Authors,
Thank you for your submission, which I have had an opportunity to review. The paper has been properly structured and written clearly.
Still, I do have some comments which would require your revision before it can be recommended for publication.
Specifically, the comments follow.
First, the paper has almost silent on the issue of the cost burden to the patients, and hence the responses from the health system. Nowadays, this issue alone could bring down the whole system. In addition, the majority of patients are sensitive to the financial burden, or factors that could potentially lead to a burden, please look at the following examples: https://www.nature.com/articles/s41599-018-0127-3 or this: https://link.springer.com/article/10.1186%2Fs40064-015-1279-x
Second, this paper, with its absence of data (albeit stated they will be provided upon request), is advised to add a small section on the "Research Study Limitations" whereby the authors should follow today's standards, please refer to this best practice one: https://www.nature.com/articles/d41586-020-01694-x
I believe addressing these will strengthen the paper's key arguments and validity.
Best wishes
Author Response
We would like to express our greatest appreciation for the helpful comments of the Reviewer that helped us to improve the paper. We could address each issue raised and are sure that the paper is now much clearer. Thank you very much for your thorough analysis of our paper!
Comment 1: “First, the paper has almost silent on the issue of the cost burden to the patients, and hence the responses from the health system. Nowadays, this issue alone could bring down the whole system. In addition, the majority of patients are sensitive to the financial burden, or factors that could potentially lead to a burden, please look at the following examples: https://www.nature.com/articles/s41599-018-0127-3 or this: https://link.springer.com/article/10.1186%2Fs40064-015-1279-x”
The Reviewer rightly pointed out the problem of patients' cost burden and their willingness to pay for health services. Vuong Q.H. et al. evaluate the sensitivity of Vietnamese healthcare consumers against two groups of factors (demographic and socioeconomic-cognitive) regarding payment for periodic GHE (general health examinations), which is not covered by insurance (Vuong et al., 2018).
Paper Vuong Q.H. (2015) represents the first research attempt to estimate the probabilities of Vietnamese patients falling into destitution due to financial burdens occurring during a curative hospital stay. Such studies tend to focus on Asia and developing countries. We did not address this issue in our research. The working and unemployed are insured in Poland and other European countries. They receive health benefits in life-threatening situations.
We included the missing parts in the section “Discussion”.
Comment 2: “Second, this paper, with its absence of data (albeit stated they will be provided upon request), is advised to add a small section on the "Research Study Limitations" whereby the authors should follow today's standards, please refer to this best practice one: https://www.nature.com/articles/d41586-020-01694-x”
As the Open Data Repository is at the developing stage in Poland, we were not able to include the proper link to the database. We included the missing information.
